If you currently do not have awebsite you could include your Facebook page, Business Twitter Account or another Social Network link.

Are you a member of a trade association/professional body? If yes tell us which one here.

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What year was the business established?(*)

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How did you find us?(*)

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Yes, I would like to receive information that could help my business.(*)

YesNoInvalid Input

Occasionally we send out useful information or requests for information to either help you grow your business or to enable us to serve you better. We keep emails to a minimum and only send out specific content related to your business.

Please check your answers before submitting, should you have any questions or require any assistance contact our brokers on 01702 225 440

Please let us know the type of cover you require.

When do you need cover to begin?(*)

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Last year's premium?(*)

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Current Insurer?(*)

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Public Liability

Please choose level of public liability required.(*)

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What is your anticipated turnover for the next 12 months?(*)

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Employers Liability

Do you require employers' liability insurance?(*)

YesNoInvalid Input

Employers’ liability insurance is a legal requirement if you employ any of the following: full-time - part-time employees/self-employed contractors you hire/temporary staff, apprentices and volunteers/people taking part in work experience or training schemes

Do you have any volunteers or unpaid workers?(*)

YesNoInvalid Input

Do you use subcontractors?

YesNoInvalid Input

Annual Manual Wage Roll?(*)

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Number of manual full/part time employees?(*)

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Number of Manual Volunteers(*)

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Annual Clerical Wage Roll?(*)

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Number of clerical full/part time employees?(*)

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Number of Clerical Volunteers(*)

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What is your employer's reference number (ERN / PAYE)?(*)

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Please check your answers before submitting, should you have any questions or require any assistance contact our brokers on 01702 225 440

All Risks Cover

Do you require cover for your equipment?(*)

YesNoInvalid Input

Is your inflatable equipment tested annually?(*)

YesNoInvalid Input

PIPA Verification or Safety Certificate Number(*)

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If not PIPA who issued the safety certificate?

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Do you hire out mechanical bulls to licensed premises?

YesNoInvalid Input

Attach Your Equipment Inventory

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For all dimension questions please state dimensions in feet, width x depth and in the cases of slides and equipment with platforms please include height and if the equipment has a round base such as a mechanical bull please give its diameter only eg. bouncy castle 12 x 12, slide 15 x 30 x 15, mechanical bull 17 dia. Thank You.

Are the premises secured by a minimum of 5 lever mortise Deadlock on all externally accessible doors and key operated window locks on all accessible windows?(*)

YesNoInvalid Input

Are the premises occupied solely by yourselves?(*)

YesNoInvalid Input

Do you have CCTV?(*)

YesNoInvalid Input

Are the premises built of brick, stone, concrete, metal or other non-combustible materials and roofed with slate, tiles, concrete, metal or other non-combustible materials?(*)

YesNoInvalid Input

Please specify buildings construction including materials used

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Has there been any previous flooding at the premises or in the neighbourhood?

YesNoInvalid Input

Do you require buildings cover?(*)

YesNoInvalid Input

Please check your answers before submitting, should you have any questions or require any assistance contact our brokers on 01702 225 440

Activity Specific Questions

Please choose static if you operate leisure equipment and provide services from 1 address even if you rent out equipment to third parties or attend shows and fairs. If however, you only hire out or attend shows with your equipment please choose mobile. If in doubt please make a note now and speak to your broker when they call you.

Is Your Business Static or Mobile?(*)

Static (i.e. Use of equipment etc from your premises)

Mobile (i.e. Hired out to third parties and erected on their premises)

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Do you undertake any work or activities outside of the UK? i.e Southern Ireland(*)

YesNoInvalid Input

Do you hire out to licensed premises(*)

YesNoInvalid Input

Please select types of licensed premises(*)

Nightclub

Public House

Community Hall

Sports Club

Social Club

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Do you or your employees supervise or are otherwise present during such licensed premises use?(*)

YesNoInvalid Input

How many years experience have you within your business' activities?(*)

Invalid Input - please use numbers only decimal place or full stop will work such as 3.6 or 5.2 etc.

Please check your answers before submitting, should you have any questions or require any assistance contact our brokers on 01702 225 440

Health and Safety & Risk Details

Do you provide full training and adequate training to all your employees?(*)

YesNoInvalid Input

Do you undertake risk assessments before the start of activities?(*)

YesNoInvalid Input

Do you have a written statement outlining safety procedures for the participants, and are these shown to the participant before the game?(*)

YesNoInvalid Input

Do you offer First Aid facilities at your location(s)?(*)

YesNoInvalid Input

Do you have an incident/accident log for minor injuries?(*)

YesNoInvalid Input

Do you give safety briefings before every game?(*)

YesNoInvalid Input

Claims History

Have you made any claims or had any claims made against you?(*)

YesNoInvalid Input

If yes please give details(*)

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Are you aware of any shortcomings that could lead to claims?(*)

YesNoInvalid Input

If yes, please give details?

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Are you aware of any loss through employee dishonesty?(*)

YesNoInvalid Input

If yes, please give details?

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Have you or any partner or director:

Ever been convicted of or charged with (but not yet tried) or been given an official police caution in respect of any criminal offence other than a motoring offence?(*)

YesNoInvalid Input

If yes, please give more details

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Ever been declared bankrupt or been a director of a company that has been declared bankrupt or insolvent?(*)

YesNoInvalid Input

If yes, please give more details(*)

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Ever been declined or refused insurance cover, had insurance cancelled or had special terms imposed?(*)

YesNoInvalid Input

If yes, please give more details(*)

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Been prosecuted in the last 5 years under Health and Safety Legislation?(*)

YesNoInvalid Input

If yes, please give more details(*)

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Does the business have any ongoing employee disputes?(*)

YesNoInvalid Input

If yes, please give more details(*)

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Material Facts

Is there any other information of which the Underwriters should be made aware?(*)

YesNoInvalid Input

Please give more details(*)

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Before submitting this form please confirm you have read and agree to the use of your data in accordance with our Privacy Policy 2018(*)

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No Liability is accepted by the insurers until the risk is accepted and the premium paid.

Please check your answers before submitting, should you have any questions or require any assistance contact our brokers on 01702 225 440